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Updated: May 15, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility
Martin J Swaans1, Martijn C Post, Benno J W M Rensing
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. m.swaans@antoniusziekenhuis.nl
Insights
Combining catheter ablation with left atrial appendage (LAA) occlusion using the Watchman device is safe and effective for drug-refractory atrial fibrillation (AF). This combined approach offers a viable alternative for patients with AF, demonstrating no interference with repeat ablation procedures.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Drug-refractory atrial fibrillation (AF) presents a significant clinical challenge, with catheter ablation success rates below 50%.
- Vitamin K antagonists, despite complications, remain a necessity for stroke prevention in many AF patients.
- Left atrial appendage (LAA) occlusion devices offer an alternative to anticoagulation for stroke risk management.
Purpose of the Study:
- To evaluate the feasibility and safety of combining catheter ablation with LAA occlusion.
- To assess the efficacy of this combined approach in patients with symptomatic, drug-refractory AF and elevated stroke risk (CHADS(2) score ≥1) or contraindications to anticoagulation.
Main Methods:
- Thirty patients with drug-refractory AF underwent simultaneous catheter ablation and LAA occlusion with the Watchman device.
- Procedures were performed using multielectrode catheters and phased radiofrequency energy.
- Patient characteristics included a median CHADS(2) score of 2.5 and 77% prior stroke history.
Main Results:
- Successful Watchman device implantation was achieved in all patients.
- At 12-month follow-up, 30% experienced AF recurrence, with no thromboembolic events.
- Repeat ablation procedures were performed successfully without interference from the LAA occlusion device.
Conclusions:
- The combination of LAA occlusion with the Watchman device and AF ablation is a safe and feasible strategy.
- This combined procedure effectively manages stroke risk in high-risk AF patients.
- The Watchman device does not impede subsequent ablation interventions.
Background:
Drug-refractory atrial fibrillation (AF) increasingly is being treated with catheter ablation. However, the long-term success rate, expressed as freedom from AF, is <50%. Therefore, vitamin K antagonists, with all their complications, remain necessary. Recently, left atrial appendage (LAA) occlusion devices were introduced as an alternative to vitamin K antagonists. Here, we investigated whether AF ablation and LAA occlusion could be a feasible and safe combination in patients with symptomatic drug-refractory AF and a CHADS(2) score ≥1 or a contraindication for vitamin K antagonists.
Methods And Results:
Ablation was performed by using multielectrode catheters with phased radiofrequency energy. LAA was occluded with the Watchman device (Atritech, Inc, Plymouth, MN). Between February 2010 and February 2011, 30 patients were treated (21 male; age, 62.8±8.5 years). Median CHADS(2) score was 2.5 (25th to 75th percentiles: 2 to 3), median CHADS-VASc score was 3 (25th to 75th percentiles: 3 to 5), 77% had prior stroke, and 27% had a contraindication for vitamin K antagonists. Median HAS-BLED score was 2 (range, 1 to 5). Successful device implantation was achieved with a median number of 1.5 devices (median diameter 24 mm [25th to 75th percentiles: 24 to 24 mm]). Total procedure time was 97 minutes (25th to 75th percentiles: 75 to 115 minutes). At 60 days, all patients met the criteria for successful sealing. Follow-up visit at 12 months showed a 30% rate of documented recurrence of AF. A repeated pulmonary vein isolation was performed successfully in 4 patients, without interference of the LAA closure device. No thromboembolic events occurred during 1-year follow-up.
Conclusion:
LAA occlusion with the Watchman device and AF ablation can be combined successfully and safely in a single procedure. The Watchman does not interfere with a repeated ablation.
